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HIV Drug ResistanceHIV Drug Resistance
           
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So many studies.....what to believe?
Jan 20, 2002

I know questions like these are difficult to answer, however I am going to ask it anyway. I have been on my first regimen of Epivir, Ziagen and Sustiva for 18 months now and doing well, never missing a dosage. Although my doctor tells me I am doing fine and assures me that I am going to live for many years to come, I am 43 years old, it is impossible to overlook the incredible statistics regarding drug resistence and long term use of these drugs to extend life. How does a person make sense of all the contradictory information out there and possitively look to the future? Is it possible to determine at this point where I stand with treatment options?

Response from Dr. Little

I think that the reason it is so hard to belive that the advice that you may do quite well on this regimen indefinitely (I also agree with your doctor) - is that there is so much data to the contrary. What you have to try and remember is that much of the information we have today is based upon the unfortunately very large amount of information on people who have been on therapy for many years and already have drug resistance - these people fail subsequent regimens much more readily than one would expect someone to fail their first regimen. This is often the result of the fact that these people were treated over the years according to our best standard of care information available during that time period. We have learned a lot about HIV care in the last few years, and now are not longer making the same treatment recommendations that we were making then (that is, we as providers have learned what it takes to make a successful treatment regimen by observing patients who participated in early trials).

We also have more drugs and more potent drugs to choose from today than we had in the past. Finally, even among your peers who started the same regimen at the same time and with the same viral load and T-cells as yourself - many will have failed by now simply due to non-adherence (ie. skipping doses). The ability to take medications twice a day for years on end and never miss a dose is a major accomplishment and - as evidenced by the number who fail - a major challenge.

We are quite confident that among people like yourself who take every dose as prescribed and never miss a dose and have regular viral load measures below the limit of detection, your future on this regimen is quite good. How long will it last - the answer really at this point is, indefinitely. Meaning, we have no reason to expect your treatment to fail at any time in the future as long as the rules outlined above are followed.

As we continue to learn more, we may have to modify these recommendations, but at present, this is true to the best of the accumulated data and study results. The biggest factor that stands to influence this advice in comming years I believe is the prevalence of transmitted drug resistant virus. That is, drug resistant virus is being transmitted from people infected with drug resistant virus to newly infected people. These newly infected people (who have never taken any antiretroviral therapy) may not have the same promising outlook to therapy, depending on the type of drug resistant virus they are infected with.


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